State News for September 2014

OHIO – Butler County officials are balking at a plan to detoxify heroin addicts in the wing of a county nursing home, while proponents of the plan say it would speed rehabilitation efforts in an area of the state riddled with a high number of opiate users.

Under the plan, the facility would refer the detoxified individuals after three to seven days to a private treatment facility. Two commissioners have expressed safety concerns for the facility's residents. They put the plan temporarily on hold in July.

Fifty-six people in the county reportedly died from heroin overdoses in the first quarter of 2014, up from 49 in 2013.

NORTHEAST

SNFs lag in electronic health

MASSACHUSETTS – Don't count the state's nursing homes as early adopters of electronic health record technology, much less so-called health information exchanges designed to facilitate the sharing of vital medical information among providers across the continuum of care.

A new report from the Massachusetts eHealth Initiative shows that doctors lead the pack in early adopters of EHR (nearly 97% now use it), while only a little more than half (55%) of skilled nursing facilities now employ the technology. Only about 8% of SNFs report participating in HIEs, according to the report.

Meanwhile, 82% of patients using a personal health record say they are more knowledgeable about their care plans, while slightly lower percentages say such access has spurred them to make lifestyle changes to better their health.

County needs more beds

NEW YORK – One of the most densely populated regions on the East Coast has more than its share of aging baby boomers while woefully lacking a long-term care system to care for them in the coming years, according to a recently published study.

The study focused on the nine counties of the Hudson Valley, northwest of Manhattan. The Hudson Valley Pattern for Progress report found that baby boomers age 80 and older would increase by nearly 55% by 2040 — 12 points higher than the state average. Meanwhile, the region's healthcare system suffers from poor outcomes, low occupancy rates among many financially distressed hospitals, shortages of nursing home beds and a weak and aging labor pool, according to the report.

Nursing homes to receive more funds, but struggle continues

MAINE – The state's nursing homes will get their first Medicaid rate increase in six years after a breathtaking display of mid-summer political brinksmanship. But dark days still loom in a state beset with closures and an over-65 population ratio that's second only to Florida's.

In late July, the Legislature approved an additional $25.8 million for MaineCare reimbursements in 2014, still far short of closing the gaping divide between costs and payments.

The bill's passage came after seesaw feuds between the Democrat-controlled Legislature and Republican Gov. Paul LePage.

The funding measure will not save 57-bed Pittsfield Rehab and Nursing, which will join another recently shuttered rural facility when it closes in September.

RHODE ISLAND – The state is the last place in the country a provider would want to be caught with a violation of patient privacy laws, according to a compliance data warehouse.

TrueVault, which tracks issues concerning the Health Insurance Portability and Accountability Act, recently found that the state was the top enforcer of violations over the decade ending in 2013, and is the only state in the country where more than 40% of violations result in corrective action. Alaska, Washington, Oregon, Idaho, Wyoming and New Hampshire also reported high enforcement levels, while Iowa, Nebraska and Kansas reported the lowest.

PLAINS

Fraud crackdown coming

SOUTH DAKOTA – Providers in the state have been notified there's a new sheriff in town, and he plans to crack down on rapidly growing cases of healthcare fraud.

U.S. Attorney Brendan Johnson, based out of Sioux Falls, told local media his office is restructuring to investigate and prosecute greater numbers of fraud cases. Meanwhile, the head of the South Dakota Association of Healthcare Organizations has pledged to continue its longstanding efforts to root out fraud and abuse in the state's hospitals and nursing homes.

Johnson said he hopes more whistleblowers will come forward using the protections of the so-called qui tam option of the federal False Claims Act, which allows people to sue offenders and claim a portion of any recovered monies. The federal government can join as a co-plaintiff in these cases.

SOUTHEAST

LTC aid plan is tabled

GEORGIA – The state's top health agency has delayed plans that would have provided relief for what is becoming a growing segment of the nation's population — people whose incomes are too high for Medicaid but inadequate to cover personal costs for health care.

The Department of Community Health tabled the plan that would have allowed lower-income state residents to access Medicaid dollars under the “medically needy” program, instead of using complicated qualified income trusts.

The delay came after some consumer groups argued the plan would limit choices and not help people under Medicaid waivers in community settings other than nursing homes and hospice care.

Home health license dispute

SOUTH CAROLINA – One of the nation's large long-term care operators has filed suit in an effort to force the state to reinstate licenses it obtained for a number of home health agencies, after a state Supreme Court ruling invalidated actions that earlier cleared the way for those licenses.

National Healthcare Corp. filed and received the licenses in four counties after the state's Department of Health and Environmental Control suspended the certificate of need program, a move spurred when Gov. Nikki Haley (R) vetoed funding for the CON program on the grounds it stifled competition, according to published reports.

The high court had ruled DHEC unlawfully suspended the CON program, regardless of the funding shortfall. DHEC had required National Healthcare Corp. to cease operations of the agencies and reapply for the licenses, a request it considered unfair.

Managed care anxieties rise

NORTH CAROLINA – The state inched closer to transitioning its Medicaid program to managed care, but the plan faces stiff opposition.

The state Senate has approved a bill that would put Medicaid under a separate agency independent of the Department of Health and Human Services. The plan also would end the agency's direct fee-for-service structure by switching to managed care and accountable care organizations.

But Democratic lawmakers and the North Carolina Medical Society say the plan would significantly increase the size of state government while disrupting delivery of services. Opponents also pointed to publicized problems with Medicaid managed care programs in Kentucky, Georgia and Illinois.

The state's Medicaid program has been plagued with budget shortfalls of more than $2 billion since 2010, according to published reports.

SOUTHWEST

Public to weigh in on care

OKLAHOMA – Lawmakers are seeking public comment several months after they tabled a comprehensive piece of legislation designed to combat elder abuse in the state's nursing homes.

House Bill 2901 would have affected nursing home staffing requirements, provided for more thorough investigations and added medical director oversight in abuse and neglect cases. Now a small group of lawmakers has launched a legislative study that will draw on testimony from family members of victimized residents.

About 3,500 state residents die each year from nursing home abuse and neglect, claims A Perfect Cause, a private advocacy group. Perfect Cause also estimates that the typical Oklahoman has a 1-in-36 chance of becoming a nursing home victim of preventable death.

Med errors on the upswing

TEXAS – State investigators issued about 200 more citations for nursing home medication errors in 2013 than they did in 2011, according to a report on an investigation by Austin-area ABC television affiliate KVUE.

There were 1,060 medication error citations in 2011, the news outlet reported. The increase in errors is mostly related to staff giving residents “unnecessary drugs.”

Recognizing the issue, the Department of Aging and Disability Services began a training program in July, focused particularly on strategies for reducing unnecessary antipscyhotic drug administration.

WEST

New LTC committee forms

CALIFORNIA – A shuttered panel charged with aging and long-term care issues has been revived by Senate lawmakers after a two-year hiatus.

The proposed new five-member Select Committee on Aging and Long-Term Care would target such issues as dementia, elder justice, housing, mental health and transportation. The proposed chairwoman, Sen. Carol Liu (D-25), said she envisions the new committee will streamline the state's long-term care systems, educate the public about aging issues and foster programs to address a diverse aging population.

Flu vaccine rates studied

OREGON – Employee vaccination rates (EVRs) are highest among the state's chain-affiliated nursing homes, not-for-profit facilities and homes with higher Medicaid populations, according to a study in the July 20 issue of the Journal of the American Medical Directors Association.

Meanwhile, the study's authors at the University of Rochester (NY) Medical Center suggest that public policy changes may be the best way to get the state's nursing homes to more uniformly provide employee vaccination programs.

While such programs are associated with lower resident morbidity and mortality, little has been known until now about the relation between nursing home affiliations and ownership structures to EVRs, researchers noted after studying 2009-2012 influenza data provided by the Office for Oregon Health Policy and Research.

WASHINGTON – Months of wrangling over a plan to fund the new Washington State Veterans Home at the Jonathan M. Wainwright Memorial VA Medical Center in Walla Walla have ended, following joint legislative and private efforts to move the project to the top of the VA's list.

Sagging federal funding had beset the proposed new facility for months.

The proposed $23 million project is forecast to add more than 90 jobs and serve more than 50,000 veterans across 10 counties. The VA currently operates three other nursing homes in the state. Included in the new plan is a complex of small houses on the medical center campus, as well as an 80-bed skilled nursing facility.